Risk factors for gastrointestinal colonization and acquisition of carbapenem-resistant gram-negative bacteria among patients in intensive care units in Thailand

This study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge.</jats:p

Prevalence and risk factors for intestinal carriage of CTX-M-type ESBLs in Enterobacteriaceae from a Thai community

The incidence of infections caused by antimicrobial-resistant Enterobacteriaceae in Thailand is increasing and human intestinal flora is an important reservoir for these organisms. This study was carried out to determine the intestinal carriage of bla CTX-M extended spectrum ß-lactamase-positive Enterobacteriaceae (ESBL + E) and AmpC-positive Enterobacteriaceae in a community setting in Northern Thailand, and to identify potential risk factors for carriage. A total of 307 fecal samples were collected from healthy volunteers in Phitsanulok province, and cefotaxime-resistant Enterobacteriaceae (CtxRE) were isolated using selective media. Polymerase chain reaction (PCR) was used to detect ESBL and AmpC genes. Risk factors were analyzed using multiple logistic regression. Genotyping was performed by multilocus sequence typing (MLST) analysis. Two hundred ninety-one CtxRE isolates were obtained and Escherichia coli was the predominant organism (66.3%). The intestinal carriage rates of bla CTX-M ESBL + E and AmpC-positive Enterobacteriaceae were 52.1% and 6.2%, respectively. Comparative levels of bla CTX-M group 1 and bla CTX-M group 9 were found while bla CMY-2 was the predominant genotype among AmpC genes. Co-existence of two ß-lactamase genes in a single isolate was found in 6.5% of isolates. Consumption of undercooked meat was strongly associated with intestinal carriage of bla CTX-M ESBL + E (p = 0.003, OR = 2.133, 95% CI = 1.289–3.530). Phylogenetic grouping and MLST analysis of E. coli isolates revealed the presence of E. coli B2-ST131 (n = 8). Of these, seven carried bla CTX-M-group 9 and 1 carried bla CMY-2. Our results suggest that residents in Thailand are at high risk for developing endogenous infections caused by antibiotic-resistant Enterobacteriaceae

Contamination of anti-vegf drugs for intravitreal injection. How Do Repackaging and Newly Developed Syringes Affect the Amount of Silicone Oil Droplets and Protein Aggregates?

Purpose: The particle counts and the nature of particles of three different antivascular endothelial growth factor agents (VEGF) in different containers in a laboratory setting were compared. Methods: Original prefilled ranibizumab glass syringes, original vials with aflibercept, and repacked ready-to-use plastic syringes with bevacizumab from a compounding pharmacy and a compounding company (CC) were analyzed. Particle counts and size distributions were quantified by different particle characterization methods (nephelometry, light obscuration, Micro-Flow Imaging, nanotracking analysis, resonant mass measurement). Using high-performance size-exclusion chromatography (HP-SEC), levels of protein drug monomer and soluble aggregates were determined. Results: Nearly all samples showed similar product quality. Light obscuration and Micro-Flow Imaging showed a 4-fold to 9-fold higher total particle count in compounding company bevacizumab (other samples up to 42,000 particles/mL). Nanotracking analysis revealed highest values for compounding company bevacizumab (6,375 million particles/mL). All containers showed similar amounts of silicone oil microdroplets. Ranibizumab showed lowest particle count of all tested agents with only one monomer peak in HP-SEC. Repackaged bevacizumab from different suppliers showed varying product quality. Conclusion: All three tested agents are available in similar quality regarding particulate purity and silicone oil microdroplet count. Repackaging can have a major impact on the quality

Environmental dissemination of mcr-1 positive Enterobacteriaceae by Chrysomya spp. (common blowfly): An increasing public health risk

Until recently, the role of insects, and particularly flies, in disseminating antimicrobial resistance (AMR) has been poorly studied. In this study, we screened blowflies (Chrysomya spp.) from different areas near the city of Phitsanulok, Northern Thailand, for the presence of AMR genes and in particular, mcr-1, using whole genome sequencing (WGS). In total, 48 mcr-1-positive isolates were recovered, consisting of 17 mcr-1-positive Klebsiella pneumoniae (MCRPKP) and 31 mcr-1-positive Escherichia coli (MCRPEC) strains. The 17 MCRPKP were shown to be clonal (ST43) with few single poly nucleomorphs (SNPs) by WGS analysis. In in-vitro models, the MCRPKP were shown to be highly virulent. In contrast, 31 recovered MCRPEC isolates are varied, belonging to 12 different sequence types shared with those causing human infections. The majority of mcr-1 gene are located on IncX4 plasmids (29/48, 60.42%), sharing an identical plasmid backbone. These findings highlight the contribution of flies to the AMR contagion picture in low- and middle-income countries and the challenges of tackling global AMR

What Is ‘Value’ and How Can We Capture It from the Product Value Chain?

The mobile phone industry is based upon the rapid development of handsets and the high turnover of devices in order to drive sales. Phones are often used for shorter periods of time than their designed life, and when discarded it is often through channels that result in lost resource. This unsustainable business model places strain on resources and creates adverse environmental and social impacts. Through interrogation of a stock and flow model, a product-service system (PSS) for a small consumer electronic device, a mobile telephone, is proposed. The points at which value may be extracted from the PSS are identified. A quantitative measure of value is proposed in order to allow the evaluation of the most appropriate time to extract it. This value is not solely monetary, but is derived from the combination of indicators which encompass environmental, economic, and technological factors. A worked example is presented, in which it is found that the precious metals within the phone are the main determinants for value extraction. These metals are found in the printed circuit board, leading to a requirement to design phones for ease of extraction of these components in order to access the value within

Comparative values of various wastewater streams as a soil nutrient source

In order to assess whether wastewaters from different industries (winery, abattoir, dairy and municipal) could be used safely to irrigate agricultural crops, a pot experiment in glass house was conducted in a sandy clay loam soil (pH = 6.12) from South Australia. Different concentrations (0, 0.05, 5, 25, 50, 75 and 100%) of the wastewaters diluted in an ordinary tap water were applied to soils sown with sunflower and maize seeds, and the effect of these irrigation treatments were evaluated at the early crop growth stages by recording the biomass yields, plant mineral nutrient contents, and also the soil chemical properties. Results showed that the winery effluent reduced the early growth of maize and sunflower when applied without any dilution, but increased yields of both plants when applied at 25% dilution with tap water. At this dilution of the winery wastewater, 80% more dry shoot yield (DSY) of sunflower and 58% more DSY of maize were obtained in comparison to the application of 100% concentration of the wastewater. Abattoir wastewater showed the highest yields at 100% concentration. Furthermore, municipal effluent did not show any inhibitory effect on both the crops. It was observed that metal contents in both the crops were different due to the application of different wastewaters, but did not exceed any toxic level. This study demonstrated that abattoir wastewater as such, and winery and dairy wastewaters at appropriate dilutions could be used for irrigation in agricultural fields to enhance crop productivity

A multi-criteria sustainability assessment framework: development and application in comparing two food waste management options using a UK region as a case study

This is a post-peer-review, pre-copyedit version of an article published in Environmental Science and Pollution Research. The final authenticated version is available online at: https://doi.org/10.1007/s11356-018-2479-

Selective laser trabeculoplasty: past, present, and future

Over the past two decades, selective laser trabeculoplasty (SLT) has increasingly become an established laser treatment used to lower intraocular pressure in open-angle glaucoma and ocular hypertensive patients. In this review we trace the origins of SLT from previous argon laser trabeculoplasty and review the current role it has in clinical practice. We outline future directions of SLT research and introduce emerging technologies that are further developing this intervention in the treatment paradigm of glaucoma.Eye advance online publication, 5 January 2018; doi:10.1038/eye.2017.273